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Workers compensation guide for employers: when a worker is injured

Purpose of this guide

This guide is to help you understand what to do and what to expect when your worker is injured.

From when the injury occurs, through the insurance claims process, and getting your worker back to work – the guide covers your obligations under workers compensation legislation along with practical advice to get the best possible outcome for your worker and you.

It explains the roles of all the people involved, who together provide a support team for your worker, including you, the insurer, approved workplace rehabilitation providers, doctors and allied health providers.

Most injured workers take little or no time off work. For those that do, the vast majority (more than 80%) return to and recover at work within the first 13 weeks.

Advice and direction in this guide is based on a strong body of research and evidence about the health benefits of work and how returning to work and where possible, recovering at work after an injury, can promote healing and facilitate recovery.

The guide helps you identify suitable work options to support your worker to recover at work. It also includes actions you can take, including support programs, if the worker is not recovering as expected.

The guide does not cover injury prevention.

NSW workers compensation system

The State Insurance Regulatory Authority (SIRA) is the government organisation responsible for regulating and administering the NSW workers compensation system and is also the regulator for workplace health and safety in NSW.

There are three types of insurers in the NSW workers compensation system:

icare

icare (insurance and care NSW) is a government organisation that delivers insurance and care services to people with workplace injuries under the NSW workers compensation scheme (known as the Nominal Insurer) and the NSW Self Insurance Corporation (known as SICorp).

The Nominal Insurer is the single largest workers compensation insurer in NSW and provides workers compensation insurance to most businesses within NSW. The Nominal Insurer contracts insurance agents to manage policies and claims on its behalf.

The five approved agents are:

Allianz Australia Worker’s Compensation (NSW) Limited

CGU Workers Compensation (NSW) Limited

Employers Mutual NSW Limited

GIO General Limited

QBE Workers Compensation (NSW) Limited.

SICorp provides workers compensation insurance to most public sector employers except those who are self-insurers. SICorp contracts insurance agents to manage policies and claims on its behalf.

The three approved agents are:

Allianz Australia Insurance Limited

Employers Mutual Limited

QBE Insurance (Australia) Limited (QBE)

Self-insurers

Self-insurers are employers approved by SIRA to manage their own workers compensation claims.

Specialised insurers

Specialised insurers hold a restricted licence to provide workers compensation insurance for a specific industry or class of business or employers.

Regardless of which type of insurer is involved in your case, they all have an obligation to support employers and their injured workers in their recovery at work and manage claim to ensure they receive their entitlements.

Your obligations

Under NSW workers compensation legislation every employer is required to:

Providing first aid

Reporting the injury

Your worker must notify you as soon as possible after an injury. A description of the injury is to be entered in your register of injuries.

Report the injury to your insurer within 48 hours of being notified. Your worker, you or your representative can make the initial notification to the insurer electronically, in writing or by telephone.

If you do not report the injury within five calendar days, you may pay a ‘claims excess payment’ which is equivalent to one week of the worker’s weekly payments.

Once reported, the insurer will provide you with a reference number which you should write down as you may need to track the notification in the future.

When reporting an injury you will be asked to provide the following information:

The worker’s name, address, contact telephone number and date of birth.

Name and address of your company.

Name of the treating doctor and contact telephone number or name of the hospital.

Date and description of the injury and details of how it happened.

Name and contact details of the person making the notification and their relationship to the worker or employer.

The following information, if available, should also be provided at the time of notification:

Step 2: Supporting your worker

Understanding your worker's situation and offering support at the time of injury and throughout the recovery process will have a positive impact on your worker's response to their injury and enable successful recovery at work.

Early contact with the doctor

A worker who is away for more than seven consecutive days as a result of a workplace injury or illness, must choose their preferred doctor (also referred to as the nominated treating doctor). Even if you have a preferred doctor or a medical practice located nearby, encourage your worker to make their own decision about where they wish to receive their treatment. Most workers choose their family doctor.

Early contact with the doctor demonstrates your commitment to the recovery of your worker and provides you with an opportunity to discuss your worker’s normal duties and the availability of other duties.
If you are unable to speak immediately with the doctor, ask the receptionist for the best way and time to do this.

Leave your details and make sure you are easily contactable. Consider sending an email or fax to the doctor with information about the nature of your business, availability of duties and your contact details.

You or your worker’s manager can provide a supportive and positive environment in the following ways:

Discourage blame

Workers compensation is a ‘no-fault’ system in NSW. Actively exploring ways to prevent future injuries and focusing on helping the worker to recover will assist in building cohesive relationships.

Keep in touch with your worker

Stay informed and inquire after your worker by regularly phoning or visiting. Find out the estimated recovery time and provide updates and news of the office or work site. Invite your worker to meetings, morning teas or social events. Reassure your worker that they are missed and the team is keen for their return.

Ask appropriate co-workers to stay in touch

Encourage your worker’s colleagues to phone, email, visit or text. If they are reluctant because they feel they don’t know what to say to the worker, reassure them that positive and considerate contact helps the worker recover. A quick chat about some general news from the workplace or other topics of interest sends a positive message to the worker.

Address and resolve any outstanding issues

A worker’s recovery can be influenced by other issues within the workplace (such as conflict with a co-worker) or at home (such as transport difficulties). These can be barriers to returning to or recovering at work. Information about cultural, psychological and social risk factors that may affect recovery and return to work outcomes is available below.

Advise your worker of their obligations

Let your worker know early on what you will do to assist in their recovery at work. Consider discussing reasonable expectations around the level of their involvement and cooperation throughout the recover at work and injury management process.

NSW workers compensation certificate of capacity

The certificate of capacity is the primary communication tool of the doctor. It is a standard form that a doctor must complete and replaces the former medical certificate.

Using the recommendations contained in the certificate will help your worker recover at work sooner. You are entitled to ask questions of the doctor and clarify the information in the certificate.

Questions you may ask include:

what can the worker do?

how long do you expect the worker to take to return to their normal duties?

can the worker drive or use public transport?

what can I do to help the worker recover at work?

how can I best communicate with you about the worker’s progress?

Seeking your worker’s permission

When signing the certificate of capacity your worker authorises the doctor to provide relevant information about their injury or illness to you and the insurer.

If you want to contact the doctor before receiving your copy of the certificate (ie during the worker’s first consultation) to show your support and discuss suitable work, you will need permission from your worker first.

Offering support throughout the recovery process will have a positive impact on your worker’s response to their injury.

Arranging a case conference

Case conferences can occur at any time throughout the claim. They are separate to your worker’s scheduled medical review. A case conference is a meeting that can include your worker, the nominated treating doctor, the insurer, approved workplace rehabilitation provider (where applicable) and yourself to set goals, ensure roles and responsibilities are understood and agree on timeframes to recover at work or return to work. Meeting with your worker and their doctor can assist in the overall management of your worker’s injury. Encourage your worker to participate in case conferences.

Other people involved

Safe and timely recovery at work or return to work is a team effort involving open, regular and caring communication. As the employer, you are a member of the worker’s support team, and you have an important role to play. The support team also includes your worker, your insurer, the doctor, and an approved workplace rehabilitation provider.

Your worker’s role

Your worker’s primary role is to focus on recovery and aim to stay at work in some capacity, or return to work as soon as possible. Your worker must find a doctor to act as their nominated treating doctor. This is often the worker’s usual general practitioner.

The insurer’s role

The insurer appoints a case manager who coordinates all aspects of the worker’s claim and is the primary contact for the support team. The insurer’s goal is to ensure your worker can return to their usual work in a timely manner with minimal disruption to your business.

The doctor’s role

Along with the usual role of assessing, diagnosing, treating and certifying patients – in the workers compensation system, the doctor supports the worker to return to work and where possible, recover at work, through appropriate clinical intervention and management.

The workplace rehabilitation provider’s role

The approved workplace rehabilitation provider can help you and your worker resolve problems associated with the recover at work or return to work process.

Approved workplace rehabilitation providers are health professionals like occupational therapists, physiotherapists, rehabilitation counsellors and psychologists who have expertise in addressing the physical, functional, psychological and/or workplace barriers that may affect a worker recovering at work or returning to work.

Step 3: Identifying duties

Under the Workplace Injury Management and Workers Compensation Act 1998 you are required to provide employment that is both suitable and, as far as reasonably practicable, the same as or equivalent to the employment the worker was in at the time of the injury4. If you cannot provide or identify suitable work, your insurer can help you with other options.

Setting your worker’s recover at work goal

Recover at work simply means helping a worker to stay in the workplace in some way following an injury, so they can use work to build and improve their capacity.

When identifying suitable work options for your worker, the goal of returning your worker to the same job as at the time of injury is preferable. Sometimes, due to the nature of the injury or other circumstances this is not possible. In these situations, the goal reflecting the most direct path back to work is recommended. When you set your goal, take into consideration the doctor’s estimation of your worker’s capacity for work. You can find this information in the NSW workers compensation certificate of capacity.

Identifying suitable work options

You don’t have to wait until you receive the NSW workers compensation certificate of capacity before you advise the worker, the doctor and others of the duties you have available.

In fact, the doctor will find it easier to match the capacity of the worker to the duties you have available if you provide this information before the consultation with the worker.

To identify suitable work options you may:

familiarise yourself with your worker’s pre-injury role

discuss work options and available duties with your worker

speak to your worker’s supervisor or immediate manager and ask for suggestions about how to organise duties to fit current work routines and schedules

review all the jobs your business has available and look at how they may align with your worker’s skill set

provide work that has been ‘put on the back burner’ or any good ideas you haven’t had time to implement

determine who else needs to be involved.

Consider the tasks closest to your worker’s pre-injury duties as your first option. Duties can be offered in any of the following ways:

the same job with different hours

modified duties

a different job altogether

at the same or different workplace

a combination of these options.

When identifying suitable work options keep the following points in mind:

Physical demands

Consider the physical demands of each task. For instance, changing a tyre might require standing, repetitive bending, twisting of the trunk and lifting and pulling heavy loads, while data entry may require prolonged sitting, prolonged and repetitive keying and sustained neck postures. Compare these demands with the doctor’s assessment of your worker’s capacity as described on their NSW workers compensation certificate of capacity. Changing your schedule of work tasks or temporarily incorporating more rest periods in jobs are ways of accommodating the physical demands of the task.

Psychological, cognitive and social demands

Consider the impacts of the injury, any medication your worker may be taking and the compensation process on your worker’s ability to manage the psychological, cognitive and/or social demands of the duties you are offering.

Risk management

Consider tasks you can eliminate or substitute to reduce the risk of further injury and protect the health and safety of the worker and their co-workers.

Training/educating

If the duties identified fall outside what would be considered usual duties, consider whether your worker requires information, training or instruction to be able to complete the duties safely.

Psychosocial factors

Consider how the worker’s personal circumstances influence their recovery at work, particularly if duties are offered at a different work site. Find out where they live and consider whether this creates difficulties getting to and from work. They may require travel assistance to help them recover at work.

Contributing to the workplace

Do the duties add value to the workplace? Duties that do not add value may cause your worker to become unmotivated. They could also lead to discontent among co-workers who may perceive the worker is not pulling their weight.

Modifying the workplace

Consider aspects of the job your worker can perform within their current capacity and explore whether they may be able to perform some or all of their normal duties with assistance.

This could include the use of equipment or modifications to the work environment. For example providing a chair to a worker with an ankle injury, who would normally stand, will enable your worker to take a break from standing for long periods while still performing their usual job.

Funding for equipment and/or workplace modifications is provided where it is necessary to allow the worker to recover at work, or to accept an offer of suitable employment. The equipment or workplace modification may be specific to your worker’s functional requirements or necessary to start a new work role.

Assistance identifying suitable work options: workplace assessment

If you are having difficulties identifying duties in your workplace to accommodate your worker’s current capacity, a workplace assessment can be arranged by your insurer.

A workplace assessment involves an approved workplace rehabilitation provider assessing your worker as they perform a range of duties and determining their capacity to perform the duties safely.

The workplace assessment findings are discussed with you, the doctor and the worker with the view to developing an appropriate recover at work plan.

You should speak with your insurer about your need for a workplace assessment.

Overcoming a lack of available duties: work trial

If you are unable to identify suitable work options that match your worker’s current capacity, a work trial can help overcome the problem.

A work trial places a worker with a host employer for a short period of time when the pre-injury employer is unable to accommodate their current capacity.

The work trial is an opportunity for the worker to recover at work while performing duties suited to their current capacity. Duties can be upgraded over a period of time (no longer than 12 weeks) until the worker reaches the required capacity to return to your business.

An approved workplace rehabilitation provider will assist you to source a work trial host and submit a proposal.

Costs associated with the work trial are funded by SIRA and are not a claims cost. For additional information see our work trial guidelines.

Demonstrating a lack of available duties

If you believe you cannot meet your legal obligations to provide suitable employment, you will need to show why.

At a minimum, you should be able to:

show who you consulted with (i.e. your worker, supervisor, other workplace manager, approved rehabilitation provider)

show that you carried out an adequate assessment of suitable or pre-injury work options

A lack of available duties does not remove your obligation to actively participate in the recover at work planning process. It is important for the worker to stay active and, therefore, imperative that alternate work options or strategies are identified.

Ways to influence recovery at work

For most people with a workplace injury, time off work is not medically necessary. In many cases, with minor and temporary job modifications, your worker can recover at work. Consider the following factors that can influence a worker’s recovery at work.

Social

Work provides valuable benefits including social interaction, job satisfaction, skill development and learning opportunities. It plays an important part in maintaining a worker’s usual routine. Talking to your worker about these benefits may encourage them to resume normal activities and routines so they can recover sooner.

Economic

If a worker is unable to perform their usual work hours, they may be eligible to receive weekly compensation payments. These payments allow workers to focus on their recovery and are structured to encourage timely recovery at work.

Communication

Research shows good communication throughout the recover at work process is critical to achieving a successful outcome. If a breakdown in communication occurs or you foresee a risk to your worker recovering at work, think about requesting help as soon as possible either by discussing your concerns with your insurer or contacting our customer service centre on 13 10 50.

Expectations

Sometimes the actions and behaviours of co-workers can have a negative impact on a worker’s recovery at work. It is important to manage expectations by keeping co-workers informed while maintaining confidentiality and putting appropriate measures in place to prevent and manage unhelpful and inappropriate behaviours.

Cultural differences

Workers from other cultures may have different values or belief systems that could impact on the way they respond to and cope with various situations. Awareness of this will help avoid misinterpretation of your behaviours or actions and any misunderstanding that may occur. If you foresee that cultural differences may impact on the recover at work process, discuss your concerns with your insurer or contact our customer service centre on 13 10 50 for advice.

Beliefs about pain

Research shows that when recovering at work, an increase in pain does not always equate to additional damage to the injury or a worsening of the condition. Some increase in pain is to be expected. However your worker may believe their pain is harmful and may avoid activities they expect to be painful.

Conflict can occur when you identify opportunities to assist your worker to recover at work and your worker perceives your action as uncaring because they believe they are unwell. You may want to help your worker get back to a normal everyday life that includes work but your worker may believe they should rest at home until they are 100 percent fit.

When addressing these issues it is crucial you remain supportive. We recommend you advise your worker to discuss their concerns about the impact of their duties on their pain with their doctor. You can also seek assistance from an approved workplace rehabilitation provider.

Flare ups

You and your worker may have concerns about the possibility of re-injury or aggravation of the existing injury during the implementation of your recover at work plan. It is best to start your recover at work planning early, gradually and consistently increasing your worker’s activity over time. This approach has been shown to reduce the risk of re-injury or progression to a chronic pain condition.

Step 4: Developing your worker's plan

Tailored planning is essential to a successful work outcome for you and your worker. Commencing the recover at work process as soon as you are notified that your worker has a workplace injury or illness can assist your worker to recover sooner.

Developing the plan

Recover at work involves adjusting your worker’s duties to match their capacity for work. It can be a gradual process where your worker returns to modified duties or reduced hours to accommodate the injury. Your worker’s recover at work plan should focus on what your worker can do rather than what they cannot. As the employer, your role in the support team is to identify suitable tasks and duties, while the doctor’s role is to identify your worker’s physical capabilities.

When developing a recover at work plan ensure you:

give the worker the opportunity to participate in the development of the plan

discuss with your worker who will receive a copy of the plan and what injury management information should be shared with co-workers

provide copies of the plan to the worker and the doctor

provide a copy of any changes made to the plan to the worker in writing.

It is good practice to:

keep a copy of the plan for yourself and give copies to the worker’s line manager and your insurer

inform line managers and co-workers (if required) of the plan’s content

monitor your worker’s progress against the plan

update the plan when the worker’s medical restrictions change or if there is a change in the workplace that impacts the plan.

Including your worker

Allowing your worker to have a say encourages commitment to the recover at work plan and improves the likelihood of its success.

Listen to your worker’s suggestions and concerns. Incorporate their input wherever possible while being clear about the options available.

If you and the worker are unable to agree to the plan, discuss the issue with your insurer and consider organising a case conference with the worker and the doctor.

Where a worker refuses to participate in a recover at work plan it is appropriate to seek assistance from
your insurer.

What to include in the plan

A template is available on our website or you can develop your own. The plan should include the following information:

Recover at work goal

Your worker’s recover at work goal needs to be clear to ensure everyone is working towards a common objective.

Your worker’s diagnosis, capacity and restrictions

Include your worker’s diagnosis, capacity for work and any restrictions specified by the doctor in the NSW workers compensation certificate of capacity. If this information is unclear, contact the doctor and ask for clarification. If you are unable to speak to the doctor directly, provide your worker with a letter to give the doctor at their next appointment.

Treatment and/or rehabilitation arrangements

Include the number, frequency and agreed times of any current and/or planned treatment or rehabilitation. Treatment appointment arrangements will be dependent on the availability of treatment providers and the individual circumstances of the worker.

Available duties and hours to be worked

Indicate duties identified in consultation with the worker. Include any workplace modifications that may be necessary and how they are to be arranged.

Supervisor arrangements

You may need to nominate a supervisor to ensure the worker works within the capacity specified by the doctor. Details of these arrangements should be described within the plan.

Review date

Regularly monitoring the plan for progress, effectiveness and updates as your worker recovers, helps support the worker, ensures arrangements are consistent with their work capacity and facilitates the identification and implementation of adjustments as required. It is recommended that you note any review dates specified by the doctor on the certificate of capacity.

Contact details

List the contact details of the support team within the plan.

Agreement

Indicate either in writing or verbally the agreement between yourself and your worker about the duties identified and the plan. If agreement is verbal you must note it in the worker’s recover at work plan.

There is no requirement for other parties to agree to the plan. However, it is best practice to seek agreement for the plan from others, particularly the doctor.

Supplementary information

As the recover at work plan is used by a range of people it is helpful to include information about:

the roles and responsibilities of people involved in the recover at work process such as supervisors, managers, return to work coordinator and co-workers

the process for handling concerns or disputes

the process for disclosing information

any additional support that helps ensure a successful recovery at work.

Preparing colleagues for your worker’s return

Feeling nervous or worried about returning to work is normal for a worker who has been off work for a period of time. Appropriate encouragement and support for your worker when they are returning and/or recovering at work is important. It is also important to make sure all staff dealing with your worker:

know the date their colleague is coming back to work

have a copy of the recover at work plan (where appropriate)

are aware of their important role in supporting the worker through the process.

Monitoring and upgrading the plan

As your worker recovers, their capacity for duties at work will increase. You can gradually upgrade the plan by:

increasing the hours of work

reducing the number of rest breaks or length of rest breaks

reducing assistance to the worker to complete tasks

requiring the worker to perform more work in the same time period (increasing the work pace)

introducing new duties that allow increased physical or functional demand.

Reviewing your plan

Informal reviews

Informal reviews may be weekly and involve a chat between you, the worker and any staff involved in your worker’s recover at work plan. Discuss the arrangements in the plan ensuring they remain relevant to your worker and workplace and identify any problems or concerns that may be emerging. In the early stages of the plan, check your worker’s progress frequently as this is the time problems are most likely to occur.

Formal reviews

The timing of a formal review is generally determined by the review date on the NSW workers compensation certificate of capacity. If your worker is progressing well and you and the worker agree to increased duties, suggest the worker make an earlier appointment to see the doctor to have their capacity reviewed.

If your worker is reporting difficulties following the plan and minor changes do not fix the problem, ask your worker to make an appointment with the doctor to have their capacity reviewed as soon as possible. It may be appropriate to consider a case conference with your worker and the doctor to discuss the issues.

Updating your plan

Over time, as your worker’s capacity increases, you will need to update your recover at work plan. Each version of the plan should describe the gradual updates to your worker’s duties and reflect their current capacity. The plan must reflect all changes, even minor ones.

When creating a new version, consulting with your worker and seeking their agreement will promote ongoing commitment to the goal.

Provide a copy of the new version to the worker.

It is also good practice to:

number each plan so everyone involved knows which is the current version eg Plan No. 1, Plan No. 2

provide copies of the revised plan to the worker’s line manager

consider the need to organise a case conference with your worker and their doctor if agreement between you and the worker cannot be reached

ensure changes to the plan are focused on achieving progress towards the agreed outcome.

Consulting with your worker and seeking their agreement will promote ongoing commitment to goals.

What to do if the recover at work plan is not working

Weekly monitoring will help you identify early if the plan is not working. Act quickly to identify the problem, discuss it with your insurer and the doctor and consider strategies that could be implemented such as:

a workplace assessment to review the worker’s capacity and/or identify additional duties to support upgrades in capacity

provision of equipment or workplace modifications.

Agree to the most appropriate strategy together and update the recover at work plan, ensuring it is distributed to all the people involved in your worker’s recovery process.

Glossary

Term

Definition

NSW workers compensation certificate of capacity

The primary tool for the nominated treating doctor or treating specialist to communicate with all parties involved in the return to and/or recover at work process. The nominated treating doctor or treating specialist is responsible for completing the certificate. The worker is responsible for providing a completed certificate to you and the insurer to be eligible for weekly payments.

Injured worker

A worker who has sustained an injury or illness at work, who is entitled to workers compensation under the legislation in respect of that injury or illness.

Nominated treating doctor

Is the medical practitioner your worker nominates (normally their GP) to manage their recovery and assist you in safely returning the worker to work.

The employment provided must be suitable and as far as reasonably practicable, the same as, or equivalent to, the employment the worker was in at the time of the injury.

Approved workplace rehabilitation provider

Organisations approved by SIRA to provide specialised workplace rehabilitation services to help injured workers recover at work and/or return to work. They are appropriately qualified, experienced and skilled to identify and design suitable work for the worker, to identify and coordinate rehabilitation strategies that ensure the worker is able to safely perform duties and ensure all impacts on recovery at work are considered.

Where to get more information

Your insurer

Your insurer will usually be your first point of contact for further information relating to any aspect of your worker’s claim and recovery at work.